The most characteristic event of hypertension is an increase in pressure.
Generally, greater pressure with hypertension can already be installed when examining the impulse.When you hear the impulse on the radial artery, a solid impulse is determined (p. Durus), due to an increase in intraarthritis pressure and the tonic reduction of the walls of the artery.However, due to the fact that the lumen of the medium caliber arteries with hypertension decreases slightly, the filling of the impulse changes little.During the graphic recording of the impulses of the impulses (on the loser), the impulse wave is low, rounded, has a lifting and descent excitement (Pulsus Tardus);The dicrotic wave is inconspicuous.
The study of blood pressure with the auscultative method is still the best way to simultaneously determine the systolic, diastolic and impulse pressure.With hypertension, all three values have generally increased.Sistolic has more significantly increased;The diastolic increases to a lesser extent.
If we compare the percentage of increasing the extent of systolic and diastolic pressure for hypertension in relation to the average values of both pressure in the norm, then the increase will be almost the same.So, if we take a normal value for systolic pressure a number of 120 mm and for diastolic pressure - 70 mm hg.Art., So at a blood pressure of 160 mm hg.Art.(maximum) and 90 mm hg.Art.(minimum), an increase compared to the norm in relation to both values will be almost the same (90 compared to 70 and 160 compared to 120).With an indicator of 180/100 mm hg.Art.At first glance, it seems that Sistolic is increasingly increased than the diastolic (180 against 120 and 100 against 70);If you compare with normal relationships, the increase in the percentage is almost the same.
Often in the initial period (Stadium I) of hypertension, there is an increase in systolic or diastolic pressure (often the first, less often the second).Perhaps it depends on the initial level it has before the disease (each person individually).
The relationship between diastolic and systolic pressure affects:
- The degree of elasticity of the walls of the great arteries,
- Socratic power of the heart.
It is known that a decrease in the elasticity of the arteries helps to increase the systolic pressure (in the most pronounced form found in the atherosclerosis of the central arteries).
With hypertension, changes are observed in the elasticity of the walls of large vessels, which is reflected in an increase in the pressure of the impulse.In the same conditions, when the heart begins to weaken, the breadth becomes lower: systolic pressure decreases, the diastolic remains increased.
Already at the beginning of the disease, an inclination to print reactions is observed.The measurement of blood pressure shows that in some patients its level does not go beyond the higher limit of age rule, but obtained when measurement the size is higher than usual for a certain person, while in others it exceeds the higher limits of the age standard.Greater pressure is observed with hypertension under the influence of various effects - mental, emotional, reflection - and is maintained at a level increased from several minutes to several hours.
The first size usually provides higher numbers (random pressure) than repeated measurements after 5-10-15 minutes.The difference between the quantity of random and basic pressure is indicated by "additional pressure";Its value in people suffering from hypertension is much bigger than healthy ones.The main pressure obtained in the conditions of the study of the main exchange is considered the main one (i.e. in bed, in the morning after sleep, on an empty stomach).The smaller value of the indicator after repeated measurements in the usual environment is conditioned by "almost the main pressure".
The "additional pressure" undoubtedly expresses the degree of mental excitation (emotional) or the patient's tension at the moment and the degree of excitability of his nervous, which regulates the blood pressure of the apparatus.Experience shows that in the prejudice period in patients, the value of additional pressure is generally more significant than people who have not found the tendency to develop hypertension.
By comparing the degree of influencing the influence of some nerve influences, it should be noted that the most acute stimulus is the word.Therefore, it will not be an exaggeration to affirm that the impact of the second signaling system in maximum measure affects the level of increase in pressure for hypertension and in the people prepared for it.
Samples for greater pressure with hypertension
They tried to determine the inclination to hypertension by reflected irritations.In this regard, particular attention was paid to the cold sample so called.In the studied after a short rest period, the blood pressure is measured in the lying position, then the brush of the other hand is immersed in a temperature of 4 ° for a minute;At the time of immersion and then every 30 seconds, the level is measured until you rent.An increase in systolic pressure is over 20 mm hg.Art., Diastolic of over 15 mm hg.Art.It serves as an indicator of an increase in the reactivity of the Press.The faces that discovered it were called "hyperreaters", who did not find - "hygoreattors".Among healthy people, hyperreaters are 15%.
The cold sample received a contradictory evaluation.In the urgent effect, with this sample, the conditions in which the sample is performed play an important role.An urgent reaction to the cold in a person who is hot, due to a reduced tone of his ships is less than that of the same person in conditions of colder external temperature.The reaction reflected in the cold depends on the usual temperature influences, the profession, on the living conditions.It is known that people are used to the temperature factor.For hardened people, a cold test can be weak and in sensitive people in cold, it can be strongly expressed.
The cold sample is based on the reflected reaction of the vasomotor center in response to a thermal irritation (and partly pain) suddenly caused by the suburbs.The urgent reaction to the cold weakens after taking alcohol, bromine, barbiturates.
Sometimes the responses to the cold sample are paradoxical: there is no greater pressure in hypertension and occasionally decreases.
It is interesting to compare these data with the results of the determination of blood pressure after the influence of heat.When heating their hands in people who suffer from hypertension, it is often not a decrease, but an increase in blood pressure (a hand lowered in hot water does not blush, but becomes pale).Therefore, cold and heat can sometimes cause the same pressing vasoconstrictor effect.
The temperature effects can hardly be used as a method to evaluate the reactivity of the apparatus that regulates the increase in pressure in hypertension, since they do not reflect the details of the disorders that are the basis of hypertension.Vascular samples have been offered that use pharmacological agents.One of these is a sample with a trinitrate of glycerol.After taking 2 drops of trinitrate of glycerol (under the language), the pressure (systolic and diastolic) decreases significantly.The decrease is more pronounced in people with a clearly increased pressure in hypertension.In particular, it decreases significantly with unstable blood pressure;Sometimes this reduction is observed with persistent hypertension.In the late phases of hypertension (with the development of arteriolosclerotic changes in the kidneys), a nitroglycerin test gives a slight decrease in the hypertension indicator, which can be used to diagnose the kidney (or stadiums) forms of hypertensive conditions.
The same results (the depressed effect) provide a test with inhalation of isoamilnitrite.The trinitrate of glycerin, such as isoamilnitrite, acts mainly through central vascular devices, thus characterizing the greater excitability of these hypertension centers.
A sodium test was somehow widespread.The person studied in bed gives a sodium amil 0.2 g every hour 3 times;The blood pressure is measured before the preparation of the drug and every half hour after taking it (within 3 hours).The difference between the initial and smaller level determines the value of the depressive effect.After taking the second dust, a dream usually occurs.Generally, the sodium Amitale helps to reduce blood pressure not only in the early hours, but also in the following days, sometimes even at several days;The well -being of the patient improves.However, such an effect is not always observed: some patients have drug intolerance.
Unlike a nitrite test, which causes a violent pressure drop, when sodium sodium is sodium, it gradually decreases.The degree of reduction of its intake is particularly significant at the beginning of the disease.At the end of the period, in the presence of arteriolosclerotic changes in the kidneys, the decrease is generally small or absent.
Since the effect of the barbiturates, without a doubt, is central, a sodium test with an ADMAL is characterized by the state of the regulatory pressure of the instrument in the cortical and subcortical regions.When using various doses of the drug (small and large), it is possible to judge the phase conditions of the nerve centers vasopressor for blood pressure (sometimes large and small doses give the same effect, or small doses have a depressive effect, more distinct than large doses).
In addition to the samples based on the action of depressio, there are many samples based on pressing - with respiratory arrest, inhalation of carbon dioxide, taking pheamine, but they are not without negative effects on the condition of patients, although probably not less than what the inclination of hypertension in its initial phase and in the only premorbid state determines.
Having discovered an inclination to a short -term increase in blood pressure in a person in particular, hypertension should not immediately diagnose, and even more to inform the examined on him.In favorable environmental conditions, instantaneous reactions can pass completely.
Increase in pressure depending on the hypertension stage
The increase in pressure in the initial phase can only be periodically (transitional phase).More in the neuropsychiatric neuropsychiatric terms, more prolonged and more frequent are periods of greater pressure in the hypertension and periods of the normal level of its shorter and rarer.Of great importance are therapeutic measures, respect for the regime.Under the influence of rest and treatment in the initial transitory phase of hypertension with a benign path, the indicator often decreases for a long time.
An increasingly stubborn inclination to the increase in pressure during the hypertension and conservation of its pathological level indicates the further development of the disease that goes to the second stage.In phase A of stadium II, blood pressure is instructed (labile phase).Its level can float with great limits.Under the influence of rest, it is reduced by a little time to a level close to normal, although it is not maintained at this level for a long time.Under the influence of the treatment, however, it is possible to obtain a prolonged reduction of the Normal indicator.
During the day, blood pressure with hypertension can vary widely.In the morning it is usually lower than in the evening.After eating, it increases slightly, then it gives a significant reduction.During night sleep, it decreases with hypertension more clearly than healthy ones.
As the disease advances, blood pressure is fixed more firmly at high level (phase B II, stable).It is true, at this stage, sometimes periods of reduction are observed.Sometimes remission occurs under the influence of prolonged therapy for a rather long time.However, usually this phase differs stubborn and high hypertension.Depressive tests at this stage indicate the functional nature of the increase in pressure in hypertension.
In phase III, blood pressure is generally resistant.Hypertension is supported by a series of factors, including undoubtedly the participation of the kidney.However, with a decrease in the etchitability of the vasopressor centers in the brain strokes or under the influence of heart failure (the occurrence of decompened on the soil of the contractile function of a hypertrophic heart), a decrease in blood pressure is observed.Moderate heart failure is not reflected much at the indicator level;Sometimes it also increases during this period (stagnant factor).
As for venous pressure in hypertension, it usually appears to be within normal limits, increases only with heart failure.True, some patients can also be found in the initial phase of the disease, different values increased in venous pressure, which have even led to the assumption of the "center of the poisoner", due to which the tone of the venous walls increases (however we are not able to judge the last, since usually the pressure of whole is measured with a way issued).Blood pressure in the capillaries is inaccessible to definition.Capillaryoscopically in the bed of nails, the narrowing of the arterial knees of the prematapillary and the expansion of the venous knees are generally determined;Typical variability of the image of the capillaries ("game" of them).